The period of transition after 1989 did not introduce radical transformations to the Montenegrin health care system. Gradual reforms started as late as in 2004 and have resulted in the sustained dominance of the public health care system over the private sector. The purpose of this chapter is to explore the effects of the public health care sector reforms after 1989 in Montenegro regarding access to and the quality and sustainability of health care services. The study is based on qualitative analysis and assessment of the provision of health care by various sectors, with an emphasis on the public sector. The chapter starts with alternative roles of the state concerning health care – as a regulator, funder/purchaser and provider/planner, and takes them into consideration further within the Montenegrin context. The research shows the mixed results of health care reform. While coverage of the population by health care services is high, there are certain gaps. There is a failure to maintain high quality, and the funding mechanisms are not sufficient for a sustainable health care system. The progress of the Montenegrin health care reforms, therefore, seems moderate.